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Types of Treatment for CLL

Treatment for cancer is usually described as either local or systemic. Local treatments remove, destroy, or control the cancer cells in one certain area. When directed at 1 part of the body, radiation therapy is an example of local treatment. Systemic treatments are used to destroy or control cancer cells throughout the entire body. When taken by mouth or injection, chemotherapy is an example of systemic treatment. In most cases, treatment for leukemia is systemic as the cancer cells are located throughout your body in the bloodstream.

You may have just 1 type of treatment or a combination. Different types of treatment have different goals. Here are some of the types of treatment and their goals for adults who have chronic lymphocytic leukemia (CLL).

Watchful waiting

Also called observation, this is a period when your doctor monitors your leukemia closely until you have symptoms or the disease is clearly progressing before treating you. Studies have shown that people with limited disease who aren't having any symptoms don't benefit from early treatment, but they might still be bothered by the side effects of the disease. During this time, your doctor can treat any problems caused by the disease, such as infection.

Chemotherapy

This is the main way to treat CLL. Its goal is to stop the growth of cancer cells, putting your disease into remission and keeping it there. During each phase of treatment, you may be treated with just one drug. Or you may receive at least 2 drugs at a time, which is called combination chemotherapy. You receive drugs by injection or in pill form, typically given in cycles. Chemotherapy may also be combined with targeted therapy or with a stem cell transplant, which is used to restore cells lost during high-dose treatment. The type and stage of CLL will determine the way chemotherapy is given.

Targeted therapy

These are drugs that target a specific part of leukemia cells without harming noncancerous cells. One example used in CLL is monoclonal antibodies, which are manmade versions of immune system proteins that can be used to try to kill leukemia cells or slow their growth. Monoclonal antibody therapy is given by infusion.

Leukapheresis

This procedure involves passing blood from an IV through a machine that removes white blood cells, including leukemia cells. The filtered blood including the remaining cells and plasma are then returned back to you through another IV. Large numbers of leukemia cells can sometimes cause problems with normal circulation. Chemotherapy is the primary treatment to lower the number of these cells, but it can take a few days to lower the cell count. Although the effect of leukapheresis is temporary, it may be advised while waiting for the chemotherapy to work.

Stem cell transplant with high-dose chemotherapy

If the normal doses of chemotherapy don't work, your doctor may need to give you very high doses of chemotherapy. These high doses can damage the stem cells in your bone marrow. Blood stem cells are the "starter" cells for new blood cells. So sometimes before chemotherapy, your doctor removes some of your stem cells and freezes them, then returns them to you after treatment to restore your body's lost blood cells. Or you may receive stem cells from a donor. This is called bone marrow or peripheral blood stem cell transplant.

Radiation therapy

This type of therapy uses high-energy X-rays to kill cancer cells or prevent their growth. It's not typically part of the standard treatment for CLL, but your doctor may recommend it in certain cases. Radiation may be used right before a stem cell transplant or, in rare cases, to shrink a tumor or an enlarged organ, such as the spleen. Sometimes your doctor may recommend radiation therapy to treat pain from bone damage that leukemia cells can cause in the bone marrow.

Surgery

A splenectomy is a surgery to remove your spleen. In rare cases, this may be advised in the treatment of CLL. Although it does not cure the leukemia, it can improve symptoms. This may be done to improve blood cell counts or to reduce pressure on other organs caused by a swollen spleen.

How your doctor decides on treatment

The choices that you have for treatment depend on these factors:

Results of your lab tests

Status of your health

Your age

Your personal needs or special considerations

Your choice of treatment also depends on these specific things about your leukemia:

Stage of your disease

Other traits of your leukemia, such as chromosome changes in the cells